Investigation of the effects of anticoagulan / antigregant therapy on perinatal results in recurrent spontaneous abortus cases with plasminogen activator inhibitor-1 gene mutation

Objective: The aim was to investigate the effects of anticoagulant / antiaggregant treatment on perinatal outcomes in patients with recurrent spontaneous abortion (RSA) with plasminogen activator inhibitor-1 (PAI-1) gene mutation. Study design: Retrospective study Place of the study: Akdeniz University Faculty of Medicine Hospital and Lara Anatolia Private Hospital Gynecology and Obstetrics Clinic Material and Method: The study was conducted retrospectively with 177 patients after obtaining local ethics committee approval from Akdeniz University Faculty of Medicine Hospital Committee Decision No: 2012-20 dated 01/08/2020. Patients between the ages of 18-45 who were diagnosed with RSA according to the criteria of The American College of Obstetricians and Gynecologists (ACOG) and American Society of Reproductive Medicine (ASRM), applied to Akdeniz University Faculty of Medicine Hospital and Lara Anatolia Private Hospital Gynecology and Obstetrics Clinic between November 2015-2019 and had 2 or more abortion history with PAI-1 gene mutation were evaluated. Patient data were accessed from the hospital automation system and patient files. Hematocrit (Hct), hemoglobin (HB), platelet count, alanine transaminase (ALT), aspartate transaminase (AST), lactate dehydrogenase (LDH), INR, blood urea nitrogen (BUN), creatinine, activated partial thromboplastin time (aPTT), hematological and biochemical parameters including prothrombin time (PT), sociodemographic characteristics, gestational week, age, gravida, parity, abortion number, maternal blood pressure and length of hospital stay, preeclampsia, eclampsia, placental detachment, pulmonary embolism, newborn characteristics; weight, height, fetal growth restriction, apgar score at 5 minutes, cord blood gas pH value, need for neonatal intensive care unit (NICU), duration of stay in NICU, temporary follow-up of newborn, respiratory distress syndrome, sepsis, perinatal ex, necrotizing enterocolitis data of the patients who applied to the clinic with a history of RSA were recorded retrospectively. Descriptive statistics were presented with frequency, percentage, mean, standard deviation (SD) and median (median), minimum (min), maximum (max) values. In the comparisons between patient and control groups in terms of continuous variables, Independent Samples t-test was used for data showing normal distribution, and Mann-Whitney U test was used for data that did not show normal distribution. In continuous inter-variable correlation analysis, Pearson correlation coefficient was calculated for variables with normal distribution and Spearman's correlation coefficient for variables not showing normal distribution. Statistical analyzes were made with the SPSS v.23 package program and the level of significance was taken as 0.05 (p<0,05). As a result of the study, there was no statistically significant difference in sociodemographic characteristics, blood pressure, hemogram and biochemical parameters between the groups who received / did not receive treatment in patients with PAI-1 gene mutation with RSA history (p> 0.05) 17 patients (9.6%) who received acetylsalicylic acid (ASA) treatment during pregnancy and 20 patients (11.3%) who received low molecular weight heparin (LMWH) treatment, 22 patients (37.3%) who received LMWH + ASA and 118 patients (66.7%) who did not receive treatment were compared. The live birth rate was 42.3% in the treated group and 22% in the untreated group. The difference between the two groups was statistically significantly higher (p <0.05). The abortion rate in the treated patient group was 55.9%, in the untreated group it was 73.7. When the groups were compared, the difference between the two groups was statistically significantly higher (p <0.05). When the data were examined in terms of neonatal height, the mean height of the babies of the treated patients was determined to be 44.8 ± 5.3 cm with standard deviation, while the mean neonatal height in the untreated group was found to be 49.7 ± 3.5 cm with the standard deviation. The mean neonatal height value was found to be statistically significantly higher in the group that did not receive treatment compared to the group that received treatment. Pregnancy complications (preeclampsia, eclampsia, placental detachment, pulmonary embolism, blood product replacement), staying in NICU, newborn birth weight, apgar score at 5 min., cord blood gas pH value, and gestational week data were not found to be statistically significant between the groups (p> 0.05). When comparing 59 patients who received combined therapy (LMWH + ASA) and 118 patients who were followed up without any treatment in terms of pregnancy outcomes, 25 of 59 patients who received treatment had live birth (42%), and 26 of 118 patients who did not receive treatment were found to have live birth (%22). The difference between the two groups was statistically significantly higher (p<0.05). While live birth rates were higher in cases using ASA and LMWH compared to other treatment groups, complication and abortion rates were lower. Results: At the end of the study, it was observed that live birth rates increased (42.3%) and abortion rates (55.9%) decreased in patients who had a history of RSA and PAI-1 gene mutation and received LMWH and/or ASA treatment during pregnancy and a statistically significant difference was shown in the treatment group (p <0.05). Comment: There sults of recent study suggests that antithrombotic therapy may have an effect on increasing live birth rates and decreasing abortion rates in pregnants have PAI-I gene mutation. Keywords: Recurrent spontaneous abortion, Thrombophilia, PAI-1 gene mutation